Pre Excercising Form | Mindset First

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Trial Booking Form

This is an Outdoor Group Trial booking form and by filling this form, you are confirming that you are safe to exercise and there are no underlying medical conditions that may put you at a risk during physical activity/exercise. It’s a filter or ‘safety net’ to help determine if the potential benefits of exercise outweigh the risks for you.

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Outdoor Group Training Trial Booking

Full Name

Date of Birth

Email Address

Mobile Number

Please select if any of below applies to you?

Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?

Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?

Do you ever experience unexplained pains in your chest at rest or during physical activity/exercise?

Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?

If you have diabetes (type I or type II) have you had trouble controlling your blood glucose in the last 3 months?

Do you have any diagnosed muscle, bone or joint problems that you have been told could be made worse by participating in physical activity/exercise?

Do you have any other medical condition(s) that may make it dangerous for you to participate in physical activity/exercise?

Today's Date

Initials or Signature

I declare that to my knowledge, the info I’ve provided is accurate & complete

Thanks for submitting!

Trial Booking Form

Outdoor Group Training Trial Booking

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